Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database
Abstract
:1. Introduction
2. Methods and Materials
2.1. Data Source and Study Population
2.2. Descriptive Analysis of the Data
2.3. Statistical Analysis
3. Results
3.1. Malignancies of Interest and Their Incidence
3.2. Graft Outcome and Patient Outcome (5-Year Follow-Up from Diagnosis)
3.2.1. Colorectal Malignancy
3.2.2. Lung Malignancy
3.2.3. PTLD
3.2.4. Renal Malignancy
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
UNOS/OPTN | United Network for Organs sharing/Organ procurement transplant network |
PTLD | post-transplant lymphoproliferative disease |
RCC | Renal cell carcinoma |
SPK | Simultaneous pancreas and kidney transplant |
EBV | Epstein–Barr virus |
CMV | Cytomegalovirus |
References
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No Malignancy (218,366) | Malignancy (12,764) | p-Value | |
---|---|---|---|
Age (Median, IQR) | 51 (39–61) | 58 (50–65) | 0.0001 |
Gender (male) | 60.3% | 64.4% | <0.001 |
Caucasian | 48.1% | 63.5% | <0.001 |
African American | 27.3% | 21.7% | <0.001 |
Type of transplant | |||
Kidney transplant | 209,294 (95.9%) | 12,241 (95.9%) | |
SPK # | 2063 (0.94%) | 14 (0.11%) | <0.001 |
Heart and kidney | 1059 (0.48%) | 92 (0.72%) | <0.001 |
Liver and kidney | 5897 (2.7%) | 415 (3.2%) | <0.001 |
Intestine and kidney | 41 (0.00%) | 2 (0.00%) | |
Lung and kidney | 43 (0.00%) | 3 (0.00%) | |
Some risk factors | |||
EBV @ high risk (D+ve, R-ve) | 6.8% | 7.2% | 0.052 |
CMV $ high risk (D+ve, R-ve) | 17.9% | 17.4% | 0.15 |
Preemptive transplant | 17.7% | 20.4% | <0.001 |
Dialysis vintage time | 1024 (470–1806) | 900 (423–1560) | <0.001 |
Deceased donor | 68.2% | 68.5% | 0.44 |
Induction | |||
Thymoglobulin | 41.6% | 40.6% | 0.03 |
Campath | 11.5% | 9.04% | <0.001 |
Simulect | 20.3% | 21.3% | 0.005 |
Multiple maintenance | |||
Tacro 1 + mmf 2 (180,009) | 170,421 (78.0%) | 9588 (75.1%) | <0.001 |
Rapa 3 + Tacro (4010) | 3743 (1.71%) | 267 (2.09%) | 0.005 |
Rapa + Tacro + mmf (1578) | 1472 (0.67%) | 106 (0.83%) | 0.01 |
Cyclo 4 + Aza 5 (682) | 635 (0.29%) | 47 (0.37%) | 0.84 |
Outcome | |||
Death-censored graft failure | 17.6% | 13.7% | <0.001 |
Death rate | 22.0% | 52.7% | <0.001 |
Type of Malignancy (Total Number of Patients) | Incidence (95% CI) 0–5 Year Follow-Up Period | Incidence (95% CI) 5–10 Year Follow-Up Period |
---|---|---|
Colorectal (494) | 2.99 (2.64–3.39) | 5.47 (4.72–6.34) |
Lung (1416) | 9.21 (8.57–9.89) | 15.68 (14.38–17.11) |
PTLD # (1936) | 15.61 (14.77–16.5) | 14.58 (13.32–15.96) |
Renal (1115) | 8.55 (7.94–9.20) | 9.46 (8.46–10.59) |
Graft Survival | ||
Malignancy | Death-censored graft failure | Diagnosis to graft survival time (days) |
Colorectal | 51 (10.3%) | 478 (163–1292) |
Lung | 108 (7.6%) | 199 (45–733) |
PTLD # | 386 (19.9%) | 471 (118–1226) |
Renal | 210 (18.8%) | 466 (100–1169) |
Patient Survival | ||
Malignancy | Total number of deaths | Time from Diagnosis to death (days) |
Colorectal | 304/494 (61.5%) | 254 (68–781) |
Lung | 1190/1416 (84%) | 151 (45–373) |
PTLD | 950/1936 (49.1%) | 175 (41–585) |
Renal | 396/1115 (35.5%) | 392 (95–1089) |
Graft Survival for PTLD types | ||
PTLD types | Death-censored graft failure | Graft survival time |
Hodgkin’s (n = 49) | 8 (16.3%) | 1094 (349–1368) |
Monomorphic (n = 666) | 124 (18.6%) | 342 (73–1168) |
Polymorphic (n = 421) | 91 (21.6%) | 491 (55–1441) |
Unspecified (n = 800) | 158 (19.8%) | 395 (93–998) |
Graft Failure Cause | Colorectal (51) | Lung (115) | PTLD # (381) | Renal (215) |
Acute rejection | 3 (5.9%) | 12 (10.4%) | 66 (17.3%) | 20 (9.3%) |
Infection | 3 (5.9%) | 4 (3.5%) | 23 (6.0%) | 6 (2.8%) |
Chronic rejection | 25 (49%) | 38 (33%) | 112 (29.4%) | 81(37.6%) |
Cancer Complications | 2 (3.9%) | 16 (13.9%) | 64 (16.8%) | 34(15.8%) |
BK | -- | 3 (2.6%) | 11 (2.9%) | 6 (2.8%) |
Others | 18 (35.3%) | 36 (31.3%) | 88 (23.1%) | 53 (24.6%) |
6 transplant nephrectomy | ||||
Missing cause of graft failure | -- | 6 (5.2%) | 17 (4.4%) | 9 (4.2%) |
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Patel, H.; Agrawal, N.; Nissaisorakarn, V.; Gupta, R.; Cardarelli, F. Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database. Transplantology 2021, 2, 253-263. https://doi.org/10.3390/transplantology2030024
Patel H, Agrawal N, Nissaisorakarn V, Gupta R, Cardarelli F. Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database. Transplantology. 2021; 2(3):253-263. https://doi.org/10.3390/transplantology2030024
Chicago/Turabian StylePatel, Het, Nikhil Agrawal, Voravech Nissaisorakarn, Ridhi Gupta, and Francesca Cardarelli. 2021. "Review of Outcomes after Diagnosis of Malignancy in Kidney Transplant Patients: UNOS Database" Transplantology 2, no. 3: 253-263. https://doi.org/10.3390/transplantology2030024